Background: There are 3.1 million unintended pregnancies in the United States annually, 49% of all pregnancies. Just under half of these pregnancies result in induced abortion(2). After an unintended pregnancy, the statistics are even more alarming: repeat abortion incidence is 11-15% over 1-3 years, and up to 21% of all women will experience repeat pregnancy within a year of pregnancy termination, with teens at significantly higher risk (3,4). Long-term career goal of applicant: To study interventions that can have a significant influence on the use of effective contraceptives and to therefore reduce the rate of unintended pregnancy among U.S. women and girls, especially via theory-based interventions in high risk populations. Primary educational goal for the grant period: To gain a deeper understanding of theory-based interventions to motivate behavior change, especially the principles and practice of motivational interviewing (MI) and the behavioral theories that support its use. To apply this knowledge to improve contraceptive use among young women at high risk for unintended pregnancy. Study design: This is a 2-phase study. During the first phase, we will develop a contraceptive counseling intervention based on the principles of MI, train counselors, and conduct a small cohort study to develop skills and refine the intervention. The second phase will be a feasibility randomized controlled trial (RCT) to determine if a large-scale RCT will be feasible. High risk population we propose to study: Women, aged 15-24 years, presenting to the University of Chicago family planning clinic for termination of an unintended pregnancy. Hypothesis: A larger proportion of women who are randomized to receive the MI counseling intervention will be using very effective contraception 6 months after the intervention. A large RCT will be feasible. Specific aims for phase 1: development of the intervention 1. Develop a 30-45 minute MI intervention to improve contraceptive use in high risk women. a. Work with research mentors and apply coursework to develop the intervention. b. Refine the intervention based on implementation and results of a small cohort study. Specific aims for phase 2 of trial: Feasibility RCT 2. Conduct a feasibility RCT comparing outcomes for women randomized to: 1) the counseling intervention designed in phase 1 vs. 2) "usual" contraceptive counseling. a. Compare outcomes between groups at 1 and 6 months after intervention. b. Use results to design large RCT for study in an R01 grant. PUBLIC HEALTH RELEVANCE: There are 3.1 million unintended pregnancies in the United States annually(2), and after pregnancy termination, up to 21% of all women will experience repeat pregnancy within 12 months, with teens at significantly higher risk(4). The proposal is for 2-phase study: during the first phase, we will develop a contraceptive counseling intervention based on the principles of motivational interviewing, train counselors, and conduct a small cohort study to develop skills and refine the intervention. The second phase will be a feasibility randomized controlled trial (RCT) to determine if a large-scale RCT of this intervention will be feasible.